Detailed overview of psychiatric hospitalization. Why psychiatric hospitalization is needed, what to expect, involuntary commitment to a psychiatric hospital and more.
Facts About Psychiatric Hospitalization
Hospitalization for psychiatric illness has undergone revolutionary changes in the last three decades. At mid-century, there were two basic sources of care for people with mental illnesses: a psychiatrist's private office, or a mental hospital. Those who went to the hospital often stayed for many months, even years. The hospital, frequently operated by the state, offered protection from the stresses of living which could be overwhelming for those with severe illness. It also offered protection from self-inflicted harm. But it offered little in the way of treatment. The use of medication as a mainstay of rehabilitative treatment had just begun.
Today people with a mental illness have many treatment options depending upon medical need: 24-hour inpatient care in general hospital psychiatric units, private psychiatric hospitals, state and federal public psychiatric hospitals and Veterans Administration (VA) hospitals; partial hospitalization or day care; residential care; community mental health centers; care in the offices of psychiatrists and other mental health practitioners, and support groups.
In all these settings, health care professionals work very hard to provide care according to a treatment plan developed by each patient's psychiatrist. The goal is to restore maximum independent living as rapidly as possible, using the appropriate level of care for the appropriate illness. Frequently, the family is involved as part of the treatment team.
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Today, people turn to psychiatric hospitals for help with a wide range of mental illnesses: families coping with the ravages of addiction; a young mother or a grandfather fighting depression; a girl whose eating disorder has put her life in danger; a young executive who cannot shake compulsions that threaten to take over his life; a once-prominent attorney who is nearly a prisoner in her own home because of phobias and anxiety; a veteran of the Vietnam war who can't seem to get over the pain of his past; a youngster whose uncontrollable and destructive behavior threatens to tear her family apart; a college freshman who is frightened and confused by strange voices and delusions.
When Psychiatric Hospitalization is Needed
A psychiatrist's decision to admit a patient to the hospital depends primarily on the severity of the patient's illness. No one is sent to the hospital who can better be treated in the psychiatrist's office or in another less restrictive setting. The presence or absence of social support--family members or other caretakers--can also figure in the psychiatrist's decision to hospitalize a patient. With sufficient social support, a person who might otherwise require hospitalization can often be cared for at home.
In much the same way a physician decides to hospitalize a person for other medical illnesses, the psychiatrist--who is a medical doctor--evaluates the symptoms to determine a treatment plan and the most appropriate treatment setting.
The procedure for hospital admission for a psychiatric illness resembles that for other illnesses. Often, that means a person's health insurance company may require a pre-admission certification before agreeing to pay for a hospitalization. Working with the psychiatrist, insurance company staff will review a patient's case and decide if it is serious enough to require inpatient care. If so, they will approve admission for a limited hospital stay, then periodically review the patient's progress to determine whether the stay should be extended. If care is denied, the psychiatrist and patient may appeal.
What to Expect in a Psychiatric Hospital
Many psychiatric hospitals and mental health units of general hospitals provide the full range of care, from psychotherapy to medication, from vocational training to social services.
Hospitalization reduces the stresses of responsibility for the patient for a brief time and allows the person to concentrate on recovery. As the crisis lessens and the person is better able to assume the challenge, the mental health care team can help him or her to plan for discharge and the community-based services that will help him or her to continue recuperating while living at home.
People in the hospital receive treatment that follows a plan developed by the psychiatrist. The therapies outlined in that plan may involve a variety of mental health professionals: the psychiatrist, a clinical psychologist, nurses, social workers, activity and rehabilitation therapists and, when necessary, an addiction counselor.
Before psychiatric treatment in any hospital begins, a patient undergoes a complete physical examination to determine the overall state of his or her health. Generally, once treatment begins, patients in the hospital receive individual therapy with a primary therapist, group therapy with peers, and family therapy with spouse, children, parents or other significant people. At the same time, patients often receive one or more psychiatric medicines. During therapy sessions, a patient can develop insights into his or her emotional and mental functioning, learn about his or her illness and its effect on relationships and daily living, and establish healthy ways of responding to the illness and daily stresses that can affect mental health. In addition, patients can receive occupational therapy to develop skills for daily living, activity therapy to learn how to develop healthy social relationships in the community, and drug and alcohol evaluation. Throughout the hospital stay, each patient works with his or her treatment team to put together a plan for continued care after the hospital stay is over.